Iloprost Intravenous Infusion for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

Monitoring as overleaf
Be careful with drug calculations - nanograms vs micrograms
A large volume of infusion may remain after the six hours infusion is complete. Any unused solution should be discarded
Prepare a new infusion every 24 hours
Unlicensed preparation

Available preparations

Ilomedin 100 microgram per 1ml ampoule

Reconstitution

Already in solution

Draw up using a 5 micron filter needle

Dilute further prior to administration

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

Each 1ml ampoule (100 micrograms = 100,000 nanograms) to be diluted in 500ml infusion fluid
This provides a final concentration of 200 nanograms per ml

Intermittent intravenous infusion (administer using an electronically controlled infusion device)

Using infusion as prepared above
Usually infused for six hours per day, rates as per guideline below
May be used as a continuous 24 hour infusion for certain Rheumatology indications (ref 2)

Dose in adults

Usual dose - treatment of severe chronic ischaemia of lower limbs in patients at risk of amputation

0.5 to 2 nanograms/kg/minute for 6 hours per day see example below
Starting dose: 0.5 nanograms/kg/minute (ng/kg/minute) for 30 minutes
The dose should then be increased at intervals of 30 minutes in steps of 0.5 nanograms/kg/minute, up to 2 nanograms/kg/minute, as tolerated
See table below for rate calculations
Stop the infusion after six hours from the start of the infusion
Dose may be reduced to previously tolerated rate if adverse effects are experienced
Repeat this titration regimen on days 2 and 3 to determine the maximum rate, which can then be used each day for 6 hours daily for up to 4 weeks
If adverse effects occur (headache, nausea, undesired drop in blood pressure), the infusion rate should be reduced in a stepwise manner
Duration of treatment
- Usually 4 weeks. It may be less in case of early efficacy

Rheumatology indications: critical digital ischaemia and acute avascular necrosis (ref 2)

Under the guidance of Rheumatology specialist
Administer as a continuous infusion of 0.5 to 2ng/kg/minute for three to five days
See table below for rate calculations

Body weight (kg)	Dose
	0.5ng/kg/min	1ng/kg/min	1.5ng/kg/min	2ng/kg/min
	Infusion rate below (ml per hour) (using a 100microgram per 500ml solution)
40kg	6	12	18	24
50kg	7.5	15	22.5	30
60kg	9	18	27	36
70kg	10.5	21	31.5	42
80kg	12	24	36	48
90kg	13.5	27	40.5	54
100kg	15	30	45	60
110kg	16.5	33	49.5	66

Renal or hepatic impairment

In patients with renal insufficiency requiring dialysis or severe hepatic impairment, cautious initial titration with a reduced dose is required (e.g. half the normal dose)

Monitoring

Blood pressure and heart rate should be monitored at the start of the infusion and subsequently after each dosage increase
Depending on the occurrence of adverse effects such as headache and nausea or an undesired blood pressure drop, the infusion rate should be reduced until the optimal tolerated dose is found
If the adverse effects are severe, the infusion should be temporarily interrupted
The treatment course can then be continued - with the dose based on the optimal tolerated dose
If the drug comes into contact with the skin, a long-lasting but painless erythema may occur. In the event of such contact, the affected area should be washed immediately with copious amounts of water or saline.

Storage

Store below 25⁰C

References

SPC UK Colonis Pharma 29/09/2021

1. Injectable Medicines Guide, Medusa downloaded Dec 30th 2021

2. Expert opinion, Prof John Carey, Consultant rheumatologist, email communication, GUH 4th Jan 2022 - strong preference for using continuous infusion rather than 6 hour infusion.

Therapeutic classification

Prostacyclin analogue

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